Essence of Healing

<body topmargin=0 leftmargin=0 marginheight=0 marginwidth=0> <table cellpadding=0 cellspacing=0 border=0 height="100%"><tr> <td valign="top" width=150 BGCOLOR="#006633" TEXT="#F7F7FF" background="056d6c00ddvuru.jpg"> <div> <IMG SRC="0733e3f0.gif" border=0 width="62" height="63" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> </td> <td valign="top" BGCOLOR="#FFFFFF" TEXT="#080000"> <div> <FONT SIZE="5" COLOR="#0066FF" FACE="Arial" ><B>Spiritual Life</B></FONT><FONT SIZE="1" COLOR="#333399" FACE="Arial" >    </FONT> |     <A HREF="index.htm" TARGET="_top" TITLE="Spiritual Life"><U>home</U></A></div> <bR> <div> Essence of Healing</div> <div> <B>2000 Catholic Press Award Winner -- 2nd Place Fall 1999</B></div> <bR> <div> <B>Touching the Spirit: The Essence of Healing</B></div> <div> By Christina M. Puchalski, M.D.</div> <bR> <div>  </div> <div> <B>THE CONNECTION BETWEEN</B> spirituality and health is currently receiving a lot of attention in both the lay and the scientific press. Some of the questions raised by these investigations are: Is religion good for your health? Should doctors talk with their patients about their patients' spiritual and religious beliefs? Should doctors pray with their patients?</div> <bR> <div> <B>Scientific Studies</B></div> <div> There is a growing body of positive evidence documenting the relationship between patients' religious and spiritual lives and their experiences of illness and disease.1 Several national surveys have documented patients' desires to have spiritual concerns addressed by their physicians. A 1990 Gallup Poll showed that religion, one expression of spirituality, plays a central role in the lives of many Americans.2 Other surveys found that seventy-five percent of Americans say religion is central to their lives; a majority feel that their spiritual faith can help them recover from their illnesses. In another survey, more than seventy-five percent of the patients believed that their physicians should address spiritual issues as part of their medical care, and about fifty percent of patients want their physicians to pray with them.3</div> <div> In addition to surveys that demonstrate that spirituality is important to people and that a significant percentage of our patients would like us to discuss their spiritual beliefs with them, a number of studies show that spirituality is beneficial to patients, particularly those with serious illnesses or life events. For example, parents whose children had died found much support after their children's death in their faith and church life.4 Patients with advanced cancer, who also found comfort in their religious and spiritual beliefs, were more satisfied with their lives, were happier, and also had diminished pain.5 Meditation has been found to be a useful adjunct to conventional medical therapy for chronic problems such as headaches, anxiety, depression, AIDS, and cancer.6</div> <div> How all of this works is unclear. A study by K. Pargament and his colleagues found that the use of religious practices, especially those in which one seeks help from God, extends the individual's coping resources and is associated with improvement in healthcare outcomes.7 Spirituality and religion offer people hope and help give meaning to people's suffering.</div> <div> Hope is an aspect of spiritual wellbeing that looks with confidence to future outcomes. Hope can change during the course of an illness. Early on, the person may hope for a cure. Later, when a cure seems unlikely, the person may hope for time to finish old projects, travel, make peace with loved ones, and have a peaceful death. In times of severe and disabling injury, hope ("the passion for the possible") may be mediated through ritual, meditation, prayer, traditional sacred narratives, or other inspirational readings. Regarding the importance of hope in the lives of people with disability, the researchers who investigated the role of spirituality in the rehabilitation and lives of those with disability concluded that spirituality-based hope is the single most important variable in patient adjustment.</div> <bR> <div> <B>Medicine and Spirituality</B></div> <div> Medical schools have now begun to teach courses on spirituality and medicine. Today, sixty-one of the one hundred and twenty-five medical schools in the United States have these type of courses, many of which are required. A fundamental aspect of these courses is communicating with patients about their spiritual beliefs. Physicians now are beginning to do a spiritual assessment as part of the regular exam. Critics of this say that spirituality and religion are too personal and that physicians should do only what belongs to their domain: heal the body.8 Healing, though, involves so much more than just the technical. Medications and surgery can treat the illness and often bring a cure, but by focusing only on the physical aspects of the patient, one ignores the dis-ease of the spirit. Healing involves more than just technical fixes.</div> <div> Illness is a major life event that causes people to question themselves, their purpose, and their meaning in life. It disrupts their career, their family life, and their ability to enjoy themselves: three areas that Freud said were essential to a healthy mind. Illness can cause people to suffer deeply. Victor Frankl wrote that "Man is not destroyed by suffering; he is destroyed by suffering without meaning."9 He noted, when writing about concentration camp victims, that survival itself may depend on seeking and finding meaning. People cope with their suffering by finding meaning in their suffering. This is where spirituality plays such a critical role. It is the relationship with the Transcendent that gives meaning and purpose to people's lives, to their joys, and to their sufferings. St. John of the Cross helps us understand suffering as a way of growth:</div> <div> There is another reason why the soul walks securely in these darknesses: it advances by suffering. Suffering is a surer and even more advantageous road than that of joy and action. First, in suffering God gives strength to the soul...second, in suffering, virtues are practiced and acquired and the soul is purified....10</div> <div> Michael Downey defines spirituality as</div> <div> an awareness that there are levels of reality not immediately apparent and that there is a quest for personal integration in the face of forces of fragmentation and depersonalization.11</div> <div> Spirituality is the dimension of human beings that seeks healing. Often spirituality is expressed as religion: </div> <div> For many people religion forms a basis of meaning and purpose in life. The profoundly disturbing effects of illness can call into question a person's purpose in life and work... Healing, the restoration of wholeness (as opposed to merely technical healing) requires answers to these questions.12</div> <div> Healing can occur anytime: in chronic illness, it may be the acceptance of limitations; in dying, it may be manifested by a transcendent set of meaningful experiences while very ill and then a peaceful death.</div> <div> It is apparent that the care of the ill person involves more than just attention to the physical. A person's mind and spirit are often affected by and may contribute to the manifestation of physical symptoms. In healing, all dimensions of a person are involved: physical, emotional, and spiritual. People may look to science to alleviate their suffering. When science fails to do so, they begin to look toward spirituality for meaning, purpose, and understanding. E. J. Cassell writes,</div> <div> Since in suffering, disruption of the whole person is the dominant theme, we know the losses and their meaning by what we know of the person who confronts us. This is what one person knows of others out of compassion for their suffering.13 </div> <div> It should be the obligation of all physicians to respond to, as well as attempt to relieve, all suffering if possible. Therefore, physicians should be able to communicate with their patients about their patients' spirituality as integral to the way their patients cope with suffering. To ask a patient about his or her spiritual beliefs is essential to knowing who the patient is, how the patient copes with illness, and how the patient can heal.</div> <bR> <div> <B>Marilyn: A Witness to Faith</B></div> <div> Marilyn was a patient of mine who had breast cancer. She was thirty-five when she noticed a lump in her breast. Biopsy results proved it was malignant. She was not surprised. It was as if she had expected the news; her mother had died of breast cancer. After a radical mastectomy and radiation therapy, she was pronounced cancer-free, but Marilyn knew it could recur. Over the next fifteen years, she dealt with recurrences, surgeries, chemotherapy, hair loss, illness, and more surgeries. Last year she died of breast cancer.</div> <div> Marilyn spoke to my second-year medical school class last year. Her reason for doing this was to educate young doctors about the importance of treating patients compassionately: with respect for who they are and not only for the disease from which they were suffering. During the class, one student asked Marilyn why it was important for her to have her physicians ask her about her spirituality. Marilyn replied, </div> <div> Because it is who I am at my deepest core. It is what makes me an individual. When I go to the hospital, my roommate often has the same disease, the same hospital gown, the same chemotherapy, and the same doctor. What makes us different is our spirit. It is unique to each of us. And I want my doctor to know who I really am: body, mind, and spirit.</div> <div> Marilyn was a beautiful person who gave of herself to others. Even while she was dying, she knitted blankets for the elderly who lived in nursing homes. Marilyn loved her family and cried many tears because she would not be with her children as they grew up. She especially identified with her daughter who would be a junior in college when Marilyn died, the same age Marilyn was when her mother died. Marilyn spent much of her time condensing a lifetime of mothering into a short amount of time, knowing she would not be here for long.</div> <div> She protected her husband from the fluctuating course of her illness. He had a difficult time with her dying, and Marilyn put aside her own pain to help him deal with his. Marilyn loved animals and had three cats who were her "angels from God," as she called them. She called the oldest one her soulmate because of what he had been through with her. Marilyn loved God and found strength in her relationship with God. She felt God's presence all through her life, and she found comfort in knowing she would be with God when she died.</div> <div> Marilyn belonged to a support group of other cancer patients from her church. They met weekly to discuss their lives and share pains and joys. They held each other in their private prayers during the week. It was Marilyn's church support group who came with her to the hospital when she had scans and other tests, tests that showed further progression of the disease. Marilyn suffered deeply from physical, emotional, and spiritual pain. She had many unanswered questions: Why did she lose her own mother at a young age? Why would her children be left motherless early in life? Why couldn't she accomplish all of her dreams? In our conversations together, I did not find answers to her questions, but I listened to her and supported her as Marilyn tried to find peace in the midst of her pain. Her faith gave her the ability to accept her suffering. John of the Cross writes of this faith:</div> <div> Faith...proposes these [divine] truths to us in its covered and inexplicit articles. The soul...says: Oh if only the truths hidden in your articles, which you teach me in an inexplicit and dark manner, you would give me now completely, clearly, and explicitly, freed of their covering, as my desire begs! She calls these truths "eyes" because of the remarkable presence of the Beloved she experiences. It seems that He is always looking at her.14</div> <div> Faith in the midst of suffering, helps us experience God. Marilyn had this profound experience, and the presence of God within her washed away the agony of her suffering. </div> <div> Marilyn had a beautiful smile that radiated joy ever time I saw her. Her inner peace showed forth, masking the weight loss and other effects of cancer on her body. She made others feel special and loved. A film crew that was shooting a documentary on the course for which Marilyn spoke were moved by her presence and by her passion for life and love. They cried during the filming but afterwards told me how her spirit made them feel at ease with her, with her illness, and with her eventual death. Marilyn, because of her profound spirituality, was not afraid of dying, and while alive she made the very most of her life. To her, every day was a gift, a blessing, and she lived her life to the fullest.</div> <bR> <div> <B>It Is about Love</B></div> <div> Each of my patients occupies a special place in my heart. Part of their spirit is always with me. My relationships with my patients are profoundly rich because we touch each other on a deep spiritual level. I try to help my patients find peace and cope with their suffering by listening to them and to their beliefs as they struggle with life's difficulties. As a physician, I try to use the best of my scientific abilities to diagnose and treat my patients. With the best technology has to offer, my patients may be cured. But, in the absence of compassion, there will be no healing. This is what a spiritual assessment is about--listening to what is important to a patient. St. John of the Cross states, "Where there is no love, put love." Often, in the midst of severe illness and suffering, the patient finds it very difficult to feel love or be loving. As people who help others in the midst of their pain, we can, as John writes, put love into their lives. Recently, when I was lecturing to a medical school grand rounds about spirituality and healthcare, one of the faculty asked the question, "Isn't this really about love?" And so, the answer is "Yes"--it is about love.</div> <bR> <div> <B>Christina M. Puchalski, M.D., OCDS</B>, is Assistant Professor at The George Washington University School of Medicine and the Center to Improve the Care of the Dying in Washington, DC. She lectures on issues of spirituality and healthcare. Her writings have appeared in the <I>Journal of the American Medical Association</I>, <I>The World and I</I>, and the <I>Los Angeles Times</I>. She is also a member of the lay Carmelites.</div> <bR> <bR> </td> </tr></table></body>